tbuckley/cabot-search huggingface dataset:
Abstract P187: Qualitative Description of Physical Activity Perceptions and Experiences in Older Adults With HIV
Authors: Harriet Fridah, Paul F Cook, Kristine Erlandson, Catherine Jankowski, Vitor Oliveira, Christine Horvat Davey, Hoai Do, Vincent Khuu, Sarah McKiddy, Allison R Webel
Journal: Circulation (2023)

Background: The benefits of physical activity, and specifically exercise, among older adults are well known. Yet, globally there is concern regarding limited engagement in physical activity and rising cases of obesity and frailty among older people with HIV (PWH). We explored the experiences and perceptions of PWH enrolled in the High-intensity Exercise study to Attenuate Limitations and Train Habits (HEALTH) study. Methods: Thirty-two participants were enrolled between February 2021 and August 2022. We conducted in-depth interviews among sedentary, older PWH in the ongoing HEALTH (NCT04550676) study. A semi-structured interview guide was informed by the two minds theory, which frames behavior change as an intention-behavior gap between two neurocognitive systems. The intuitive system, described as immediate or first reactions, optimizes behavior based on its expected consequences at the moment, whereas the narrative system produces beliefs about possible behavior in the future sequentially and thoughtfully. Interviews explored general exercise perceptions, self-efficacy for exercise, mobile health intervention tailoring, outcome expectations and goals for physical activity. Interviews were transcribed verbatim, and a three-member study team employed deductive and inductive thematic analysis using Dedoose. The sample size provided sufficient data to reach saturation. Results: Physical activity was perceived as the ability to maintain daily living activities and address health goals such as becoming and maintaining physical fitness. Previous experiences with physical activity varied among participants and were influenced by chronic illnesses, motivation and interest in physical activity, and availability of social support. Congruent with the two-minds theory, participants reported intuitive-level experiences as barriers to physical activity. These include antiretroviral side effects, lack of self-confidence, and aging. COVID-19 was also noted as a significant barrier. Consistent with the narrative system, participants identified changes in health status, feeling better and having improved sleep, body changes (e.g., weight loss), and changes in relationships as reasons for and benefits of physical activity. Additionally, most participants reported lifestyle changes such as quitting substance use, diet changes, and changes to their social network, all of which helped sustain their increased physical activity. PWH felt that conversations with their healthcare providers supporting their exercise goals was critical to helping them engage in physical activity, but was rarely received. Conclusion: Understanding how older PWH experience and perceive physical activity is critical to developing tailored strategies and structuring service delivery within the healthcare setting to improve health by supporting a physically active life.
Abstract P268: The Impact of Social Determinants of Health on Treatment Adherence in Heart Failure Patients: A Narrative Review
Authors: William B Burrows, Mary E Leigh, Meredith S Duncan, Anna Kucharska-Newton
Journal: Circulation (2023)

Introduction: Although effective treatments have reduced the number of deaths attributable to heart failure, there is a growing burden of sub-optimal disease management. Studies have shown that only ~50% of heart failure patients demonstrate treatment non-adherence. Although several known social determinants of health (SDOH) impact incidence and prevalence of heart failure, the intersection between treatment adherence and SDOH and its effect on heart failure patients remains understudied. Methods: This narrative literature review aims to identify the effects of SDOH on treatment adherence in heart failure patients. Keywords and MeSH terms were selected to encapsulate SDOH, heart failure, and treatment adherence. Using those terms, a literature search of all studies published from 2006 through 2022 in English or with an available translation was completed using PubMed, CINAHL, and Web of Science. Of the 61 articles identified we removed 9 duplicates, resulting in 51 original articles. Following title and abstract review, 36 articles were selected for full review, following which 8 were included in the final literature review. Results: Seven studies were conducted within the United States, one in Italy, and one in Central and South America. The outcome, treatment adherence, was defined as medication adherence (63% of studies, 5 of 8), self-care index (13%, 1 of 8), participation in cardiac rehabilitation (13%, 1 of 8), and lifestyle changes (13%, 1 of 8). Of the studies reviewed, the most frequently examined SDOH were sex (88%, 7 of 8), income (75%, 6 of 8), and education (50%, 4 of 8). Fewer studies included race/ethnicity (38%, 3 of 8), region (25%, 2 of 8), or social support (13%, 1 of 8). Income, social support, and education were correlated with low treatment adherence. High rates of cardiovascular hospitalizations were observed in those with low adherence. Results surrounding sex were mixed; one study showed female sex as protective on treatment adherence while a second study suggested an adverse effect. No studies examined the association between rurality or access to healthcare with treatment adherence in heart failure. Conclusion: Several SDOH impact treatment adherence in heart failure patients. However, studies examining the impact of SDOH outside of sex, income, ethnicity, and studies examining components of heart failure treatment, outside of medication adherence, are lacking. This narrative review highlights the paucity of literature investigating facets of treatment other than medication adherence. Additionally, future research should include more robust and informative measures of SDOH to inform strategies for the management of heart failure.
Abstract P311: Lifestyle Factors Substantially Contributed to Urban-Rural Disparity in All-Cause Mortality Among Chinese Adults 65 or Older
Authors: Xiong Ding, Kehan Su, Qi Guo, Shangzhi Xiong, Yaxi Li, Yikai Ling, Zhengting He, Xian Zhang, Lijing L Yan
Journal: Circulation (2023)

Background: Studies on whether lifestyle factors could explain urban-rural differences in mortality risks among Chinese adults 65 years or older are limited. We aim to assess whether and to what extent individual-level lifestyle factors contribute to urban-rural disparity in mortality among older Chinese adults. Methods: Our study included a total of 37,083 adults 65 years or older residents (8,522 city, 8,022 urban and 20,539 rural) from seven waves of the Chinese Longitudinal Healthy Longevity Survey (1998-2014), with follow-up to the latest wave (2018). Five lifestyle factors were examined: smoking, drinking, physical activity, diet and leisure activities. All-cause mortality was ascertained through death registry and information from next of kin. We conducted multivariable Cox proportional hazard models to examine mortality risks and used two measures to estimate the contributions to urban-rural mortality disparity from lifestyle factors, PERM (percentage excess risk mediated) calculated by the change of hazard ratio of the different models divided by the hazard ratio of the adjusted demographics model and AUC (area under the receiver-operating curve). Results: During a median follow-up of 3.24 years, 23,576 death cases were recorded. Report crude differences (death rates by the 3 groups city, town, rural) before adjusting for any vars. After adjusting for demographics, the hazards for town and rural residents were 8.8% and 17.2% higher than city residents, respectively (Table 1, Model 1). Adjustment for leisure activities made the largest difference in explaining the urban-rural disparities (Model 6). Adjustment for all five lifestyle factors explained 36.6% of city-town and 26.1% of city-rural differences (Model 7). AUCs for all models were &gt; 0.7. Conclusion: Lifestyle factors, especially leisure activities, physical activities and diet, contributed substantially to the urban-rural disparity in all-cause mortality of adults aged 65 years or older in China.
Abstract MP71: Associations Between Physical Activity Trajectories and Nonalcoholic Fatty Liver Disease: The Cardia Study
Authors: Junia N de Brito, DJ McDonough, Mahesh Mathew, Lisa B VanWagner, Pamela J Schreiner, Kelley Pettee Gabriel, David R Jacobs, James G Terry, John Jeffrey Carr, Mark A Pereira
Journal: Circulation (2023)

Introduction: Non-alcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver disease in the US. Weight loss and lifestyle modifications, including increases in physical activity (PA), are the primary therapeutic recommendations for managing NAFLD. However, little is known about longitudinal physical activity patterns and NAFLD prevalence among a racially diverse population of adults. This study aimed to (1) identify distinct physical activity trajectories from young to middle adulthood and (2) examine the associations between physical activity trajectories and NAFLD prevalence in middle-aged adults. Methods: The analytic sample included 2833 participants of the Coronary Artery Risk Development in Young Adults (CARDIA) study. Physical activity was self-reported at eight examinations over 25 years (1985/1986 to 2010/2011), and separately scored for moderate- (MPA) and vigorous-intensity (VPA) physical activity. NAFLD was defined as liver attenuation values ≤51 Hounsfield units after exclusion of other causes of liver fat, measured using computed tomography in year 25 (2010/2011). Group-based trajectory modeling was used to identify MPA and VPA trajectories over 25 years. Modified Poisson regression models were used to estimate the risk ratios (RR) of NAFLD across the PA trajectories, adjusted for year 25 sex, age, CARDIA study center, race, education, smoking status, dietary pattern, and alcohol consumption. Results: We identified three distinct MPA and VPA trajectories. MPA: ‘very low stable’ (53%), ‘low stable’ (39%), and ‘moderate increasing’ (8%). VPA: ‘low stable’ (57%), ‘moderate stable’ (36%), and ‘high decreasing’ (7%). Year 25 NAFLD prevalence was 24%. Relative to participants with ‘moderate increasing’ MPA over time, those with lower levels of MPA had adjusted risk ratios of 1.11 (95% CI 0.87-1.43) for ‘low stable’ and 1.11 (95% CI 0.86-1.42) for ‘very low stable.’ Relative to participants with ‘high decreasing’ VPA over time, those with lower levels of VPA had adjusted risk ratios of 1.26 (95% CI 0.95-1.69) for ‘moderate stable’ and 1.62 (95% CI 1.21-2.16) for ‘low stable.’ Conclusions: Our results suggest a higher risk of NAFLD in middle age for those with low levels of VPA from young to middle adulthood relative to those with the highest levels of VPA over time, with evidence of dose-response. Sustaining VPA throughout adulthood may be efficacious in the prevention of NAFLD, highlighting the importance of targeted delivery of prevention and management programs aimed at modifying lifestyle risk factors to reduce NAFLD risk.
Abstract P175: Shared Medical Appointments in Heart Failure for Post-Hospitalization Follow-Up
Authors: Tracey H Taveira, Lisa Cohen, Sherry Ball, Sherry K Laforest, Julie A Gee, Kimberley Schaub, Sandesh Dev, Melanie Parent, Rene Hearns, Wen-Chih H Wu
Journal: Circulation (2023)

Introduction: Shared medical appointments (SMAs) are medical visits where several patients with a common disease have clinic at the same time with medical provider(s). SMAs in heart failure (HF) is a unique opportunity where providers of different disciplines, one of which is a prescriber with HF expertise, can improve the health of patients recently discharged with HF. Hypothesis: Compared with usual care, patients discharged with HF randomized to a HF-SMA will experience better cardiac health status as measured by Kansas City Cardiomyopathy Questionnaire (KCCQ) and overall health status as measured by the EQ-5D Visual Analog Scale (EQ5D-VAS) Methods: We conducted a 3-site open label randomized-controlled trial of parallel design. Participants within 12 weeks of a HF hospitalization were randomized to receive either HF-SMA versus usual care. The HF-SMA team consisted of a nurse, nutritionist, psychologist, nurse practitioner and/or a clinical pharmacist and included four 2 hour sessions that met every other week for 8 weeks. Primary outcomes are overall health status measured by EQ5D-VAS (range 0-100 with 0 = worst health and 100 = Best health) and cardiac health status by KCCQ (range 0-100, higher score is better cardiac health), after 180 days post randomization. Results: Of the 242 patients enrolled (mean age 69.3±9.4 years, 71.5% white, 94.6% male), 83.8% HF-SMA and 84.8% usual care participants completed the study. Although both groups had significant improvements from baseline in their overall health status, patients in the HF-SMA intervention experienced a greater improvement in EQ5D-VAS scores than usual care (change = 7.2 ± 15.8 versus -0.4 ± 19.0 points, p&lt;0.001, respectively). There were no significant differences between the groups in the cardiac health status KCCQ Summary or Clinical Scores. Conclusion: HF-SMA achieved higher Improvements in overall health status than usual care but not in cardiac health status. Future studies should power to compare data on event outcomes to better understand impact.
Abstract P562: Body Size Dissatisfaction is High in African Immigrants With Obesity: Insight From the Africans in America Cohort
Authors: Jamaiica S Hurston, Elyssa M Shoup, Jean de Dieu Gatete, Charlita C Worthy, Blayne R Schenk, Lilian S Mabundo, Christopher W DuBose, Margrethe F Horlyck-Romanovsky, Ram Jagannathan, Anne E Sumner
Journal: Circulation (2023)

Background: In African populations, attitudes towards both optimal body size and healthful weights are evolving. Due to the adverse effect of obesity on health, larger body sizes are beginning to be seen as less ideal. Our goal was to determine body size satisfaction in African immigrants who were obese. Methods: The participants were 326 African-born Blacks enrolled in the Africans in America cohort and living in metropolitan Washington DC (female: 39%, age 40±11y (mean±SD). The African region of origin of the participants were: West: 49% (161/326), Central 12% (39/326) and East: 39% (126/326). Twenty-seven percent (89/326) of the countries of origin were francophone. Enrollees were asked to rank their current body size and ideal body size according to the Stunkard Figure Rating Scale. Body size satisfaction was determined by the difference between perceived and wish body size. Results: BMI was higher in women than men (29.1±4.9 vs. 27.0±3.9 kg/m 2 , P&lt;0.001). The overall prevalence of obesity was 27% (88/326) and higher in women than men (38% vs 20%, P=0.001). Among participants with obesity, there was no difference by sex in degree of dissatisfaction due to high body size (OR 2.14, 95% CI: 0.48, 9.58, P=0.32). Attitudes towards body size in participants with obesity were: 1% (1/88) considered themselves too small, 8% (7/88) just right and 91% (80/88) too large (Figure). These results did not vary by African region of origin or francophone status. Conclusions: The majority of African immigrants with obesity were dissatisfied with their high BMI. To optimize health, risk factors associated with weight gain and body size dissatisfaction should be addressed.
Abstract P574: Does Being Multiracial Matter for Chronic Disease? An Evaluation of Differences in Obesity by Multiracial Subgroups in the U.S.
Authors: Rebecca E Jones-Antwi, Liliana Aguayo, Natalia Poveda Rey, Solveig Argeseanu Cunningham
Journal: Circulation (2023)

The multiracial population is considered the fasted growing population in the United States. In 2020, the percentage of people who reported multiples races changed more than all of the single race groups, increasing from 2.9% of the population (9 million people) in 2010 to 10.2% of the population (33.8 million) in 2020. Each multiracial subgroup has unique social and political histories that may lead to distinct social perceptions, economic situations, and health outcomes. We hypothesized that there is a multiracial distinction in the prevalence of obesity. On average multiracial respondents will have better or worse than both single-race component groups. We assessed whether the patterns of obesity of adults who identify as multiracial are distinctive from that of adults who identify a single-race identity, by using a three-year (2010-2012) pooled sample of the Behavioral Risk Factor Surveillance System (BRFSS). We further investigate whether the prevalence of obesity in multiracial versus single-race individuals differ among Hispanic and non-Hispanic subgroups. Results show that categorizing all multiracial individuals into one group masks the different patterns of obesity within multiracial individuals. White-Black, White-Asian, White-Native Hawaiian/Pacific Islander (NHPI), and White-American Indian adults have a prevalence of obesity in between their single-race counterparts (Figure 1, Panel A). Among Hispanics, the prevalence of obesity in White-Black and Black-America Indian adults is lower than the same categories among non-Hispanics (Figure 1, Panel B). Whereas the prevalence of obesity in White-NHPII and Asian NHPI is higher than the same categories among non-Hispanics. This study helps us address aspects of the social construction of race and the complexity in evaluation of obesity prevalence. Findings raise further questions about the usage of a homogenous multiple race categorization in national surveys.
Abstract P137: Dietary Omega-3 Fatty Acid Consumption and the Incidence of Atrial Fibrillation in the Million Veteran Program
Authors: Eric T Guardino, Yanping Li, Xuan-Mai T Nguyen, Peter W Wilson, J. M Gaziano, Kelly Cho, Emelia J Benjamin, Luc Djoussé on behalf of the VA Million Veteran
Journal: Circulation (2023)

Background: Although recent large randomized clinical trials showed an increased risk of atrial fibrillation (AF) with marine omega-3 fatty acids supplements, it is unclear whether dietary marine omega-3 fatty acids assessed through food frequency questionnaires are associated with AF risk. Hence, we sought to test the hypothesis that dietary eicosapentaenoic acid/docosahexaenoic acid/docosapentaecnoic acid (EPA/DHA/DPA) is associated with a higher risk of AF in a large prospective cohort of US Veterans. Methods: We analyzed data from Million Veteran Program participants who completed self-reported food frequency questionnaires. We used multivariable Cox regression to estimate hazard ratios of AF across quintiles of omega-3 fatty acids consumption and a cubic spline analysis to assess the dose-response relationship between omega-3 fatty acids and AF. Results: Of the 301,294 Veterans studied, the mean intake of omega-3 fatty acids (EPA/DHA/DPA) was 0.39 g/day (SD 0.38), the mean age was 64.9 (SD 12.0) years; 91.2% (274,881 of 301,294) male and 84.0% (253,144 of 301,294) White. Consumption of EPA/DHA/DPA exhibited a non-linear inverse relation with incident AF characterized by an initial decline to 11% at 0.75 g/day of marine omega-3 fatty acids intake followed by a plateau. Conclusions: Contrary to our hypothesis, dietary EPA/DHA/DPA was not associated with a higher risk of AF but was inversely related to AF risk in a non-linear manner.
Abstract MP61: Starch Digestion-Related Amylase Genetic Variants, Dietary Carbohydrates, and Changes in Glucose Tolerance: Results From the OmniCarb Trial
Authors: Yoriko Heianza, Xuan Wang, Hao Ma, Lawrence J Appel, Frank M Sacks, Lu Qi
Journal: Circulation (2023)

Introduction: Salivary amylase, encoded by the AMY1 gene, plays a pivotal role in carbohydrate digestion, and genetic adaptation of carbohydrate digestion has been implicated in impaired glucose tolerance, type 2 diabetes, and cardiometabolic diseases. Hypothesis: We investigated whether AMY1 genetic variations are associated with β-cell function and glycemic responses during 2-h oral glucose tolerance tests (OGTTs) and tested whether AMY1 variations were related to changes in glucose tolerance in a randomized controlled trial testing effects of diets varying in glycemic index (GI) levels and carbohydrate (Carb) amount. Methods: The study included participants (n=146) from the OmniCarb trial, a randomized crossover-controlled feeding trial, in which overweight or obese adults were given 4 diets that differed in composition by GI and Carb amount. Each diet was consumed for 5 weeks, followed by a 2-week washout. Genetic risk score (GRS) was calculated using eight AMY1 SNPs, with higher GRS indicating higher activity of salivary amylase. The primary outcomes were glycemic and insulin responses during OGTTs. Results: At baseline, lower GRS was related to a larger area under the curve of glucose (AUC-glucose) and β-cell dysfunction assessed by the insulinogenic index and disposition index ( p &lt;0.05 for all). After consuming either a high-Carb and low-GI diet or a low-Carb and high-GI diet for 5 weeks, participants with low GRS (tertile 1) showed impaired glycemic responses at 30, 60, and 90 min after OGTTs, as compared to those with high GRS (tertile 3); there was no significant difference according to GRS after eating a low-Carb/low-GI diet. After consuming a high-Carb and high-GI diet for 5 weeks, the participants with low GRS showed a mean 21 (SE 10) mg/dl higher glucose concentrations at 60 min after OGTT, as compared to those with high GRS ( p =0.038). The effect of increasing GI at low Carb amount for glucose levels at 60 min ( P interaction = 0.024) and AUC-glucose ( P interaction =0.016) significantly interacted with the GRS. Also, we found a significant interaction between GRS and the effect of increasing Carb amount at high GI for 60-min post-load glucose levels ( P interaction = 0.016). Conclusions: The AMY1 genetic variations were associated with β-cell function and impaired glucose tolerance. Effects of changing the amount or quality of carbohydrates on glucose tolerance may be partly determined by individual genetic adaptation of carbohydrate digestion.